TAIWAN LOURDES ASSOCIATION
2007 ANNUAL WORK REPORT
BACKGROUND INFORMATION
HIV EDPIDEMIC DEVELOPMENT IN TAIWAN
The total number of HIV cases by December 31, 2007 was 15,641. In the past couple of years, the risk factors have shifted from sex to drug use. The transmission rate of IDU (Intravenous Drug Users) accounted for about 40% of HIV population. 66% of the HIV drug users were diagnosed when they were in the prisons.
The government has quickly responded to the HIV transmission outbreak among drug users by introducing harm reduction programs. The government provides free methadone treatment and clean needles islandwide. Fortunately, the new HIV cases among drug users have decreased in the last two years. However, the HIV transmission among the gay men has increased in the last two years, because the focus and the resources of HIV prevention were targeted on drug users.
THE NEEDS OF CARE AND SUPPORT SERVICES IN TAIWAN FOR PEOPLE LIVING WITH HIV/AIDS (PLWHA) IN TAIWAN
The lion's share of the government's AIDS budget was spent on treatment and prevention. Only about 1% of the budget was spent on care and support programs. The government provides free antiretroviral treatment to people living with HIV/AIDS (PLWHA), however the patients have to pay a small amount of the hospital administrative fees and share some medical bills. Poor PLWHA struggles with the expenses, especially the drug users.
The PLWHA cannot access social services because of discrimination and prejudice. The disability benefits do not include PLWHA. Therefore, the care and support of PLWHA completely depend on AIDS Non-government Organizations (NGOs).
The human rights of the PLWHA are violated. They are rejected when their HIV status is disclosed in the hospital, school, workplace and community. Fortunately, the legislators approved the bills of protecting the human rights of the PLWHA at the end of 2006, hence the Department of Health has drawn regulations for protecting the rights of PLWHA on education, medical, employment and residential care.
Any HIV positive foreigner who does not have a Taiwan Identity Card has to be deported. Some foreign women married to Taiwanese husbands have been infected by their husbands. The AIDS NGOs have to fight for their rights and take care of them while they wait for deportation.
There are only 5 AIDS NGOs to provide direct care and support services to PLWHA in Taiwan. Two of these AIDS NGOs have only a couple of staff members. The AIDS NGOs are under much pressure and workload as the number of PLWHA has increased yearly. There are very few programs and services for drug users. The AIDS NGOs have to learn and cope with the urgent demands of the drug users.
TAIWAN LOURDES ASSOCIATION
Lourdes Association was set up by the Daughters of Charity in 1996. It is the only Catholic organization for HIV/AIDS in Taiwan. Lourdes Association has main office is in Taipei (north of Taiwan ) and a branch office is in Taichung(central Taiwan ). The PLWHA accounts for about 3/5 of HIV/AIDS population in these two areas.
There are 14 staff members including 10 professional social workers and counselors, 3 HIV positive co-ordinators for peer support and activities, and 1 accountant.
It is our goal to improve the quality of life of PLWHA through our various care and support services and programs.
IMPLEMENTATION OF THE SERVICES
The services and programs we provided in 2007 are as follows:
(1) Case Management:
We contacted more about 4,000 clients through our various services and outreach programs. We provided case management for 460 cases in 2007. 50% of the clients were HIV drug users or HIV ex-prisoners.
Many of the HIV drug users were rejected by their families for their offences and criminal records. Some of them had been in and out of the prisons for a couple of times. Most of them were from low social-economic families and had very low education achievement levels.
The basic information about the 390 opened cases:
Sex: 90% were male and 10% were female. The number of male clients was high, probably because of most of the drug users were male.
Age: 30% were 21-30 years old and 37% were 31-40 years old. The numbers of above 50 years old have slightly increased more than in 2006. It showed the needs of services for aging HIV clients.
Location: 40% were from Taipei area and 45% were from Tai Chung area. That reflected the accessibility of our two offices in Taipei and Tai Chung.
The sources of the clients: 40% from themselves; 18% referrals from hospitals and public health workers; 16% from the prisoners or ex-prisoners; 16% from their families and friends; 11% from outreach work. The numbers of the clients from themselves and families increased more than that in 2006. It showed that PLWHA broke through the stigma and asked for help. It also showed that our services were well recognized.
The needs of the clients: 30% basic needs for living, 22% support, 19% emotional problems, 21% AIDS treatment and care information.
The following services were provided through the case management program:
Financial Aid: some PLWHA did not have means to pay for insurance premium, rent or living expenses, especially those who had just been released from the prisons. We provided financial aid to clients in need for 1,020 times with a total amount of US$ 33,300 in 2007. 76% of the financial aid was for ex-prisoners. 53% for living expenses, 38% of the financial aid was for rent, and 8% for medical expenses.
Residential Facilities: we had houses to provide temporary accommodation to those who were rejected by the family or unemployed. 61 times people stayed in our residential facilities and 29 of them were drug users.
Referral Services: we referred 72 times clients to other organizations, such as drug programs, homeless care, nursing care, financial aid agencies, etc.
Emotional Support: We made 961 telephone calls to give support to PLWHA.
(2) Counseling Services
We provided 620 counseling sessions to PLWHA who were emotionally disturbed and had difficulties in their lives. These aim to help the client to achieve independent living through our case management and counseling.
(3) Outreach Service
We regularly visited HIV outpatient clinics and inpatient wards in 6 AIDS hospitals. We contact potential clients through out-reach work. We also visited some clients at their homes when they were house-bound or needed support. In 2007 we visited 436 times people at hospitals and homes. Since the clients more openly and initiatively contacted us for help, therefore the outreach services have gradually decreased in 2007.
(4) Peer Support Services
Lourdes Association operates two Friendship Centers for PLWHA in Taipeiand Taichung . People infected with HIV/AIDS in Taiwan live a very isolated life. It is our goal that our HIV friends support each other through our various support programs and activities. 4,029 participants visited our Friendship Centers in 2007. Our HIV positive staff members and volunteers welcomed and chatted with them during their visits.
We provided the following programs in the Friendship Centers in 2007:
l 11 workshops with topics related to treatment and self-care were organized with 153 participants.
l 131 times of support groups, reading groups and self-development weekend residential workshops and were organized with 1,237 participants. The self-development weekend residential workshops aimed to give spiritual care through deep sharing, meditation, painting, music and psychodrama. The support groups for newly diagnosed gay men have been very popular and well attended.
l 54 times of meals together, outing, recreational activities were organized with 806 people.
l 3 memorial and 4 Christmas parties were organized with 250 participants.
(5) Support Services to the HIV Prisoners
66% of HIV drug users are diagnosed in prisons. Prisoners who are infected with HIV/AIDS are very isolated in the prisons. There is strong discrimination against HIV prisoners in the justice system. The HIV prisoners are segregated from other inmates and have very few activities and support.Therefore the prison visit is one of our major outreach services, and correspondent services are also provided. Sometimes, negotiating with prison officers on behalf of prisoners has been one of our most difficult tasks for the prison services.
Prison Visits: 10 social workers and 17 volunteers regularly visited HIV prisoners in 21 prisons and detention centers. We provided HIV treatment and care information, individual counseling, group counseling and activities. In 2007, we made 620 visits and provided services to 8,870 participants.
Preparation for leaving prisons: The social workers and the therapist volunteers gave individual or group counseling. The social workers helped the prisoners who would be released shortly through individual counseling.
(6) HIV Drug Users Services
According to the Department of Health, there are about 6,000 drug users infected with HIV/AIDS through sharing needles. 66% of HIV drug users were diagnosed in prisons. There is an urgent need to work with HIV drug users when they are released from the prisons in order to avoid relapse into addiction and criminal activities. Many of them are rejected by their families for their offences and criminal records. Some of them have been in and out of the prisons for a couple of times. Most of them are from low social-economic families and have very low education achievement levels. The HIV drug users need support and social work intervention. However, there are very few social care programs for drug users in Taiwan. A couple of Christian organizations offer therapeutic communities abstinence treatment based on the 12-steps theory. Most of the programs reject those infected with HIV/AIDS.
Lourdes Association provided case management and counseling services to the drug users as done for other clients. We opened drop-in centers for them and provided Harm Reduction support groups. We explored drug issues, harm reduction approach, emotional management, etc. We also made referral to methadone and needle exchange programs.
40 Harm Reduction support groups were organized with 351 participants in 2007. 30 HIV drug users participated more than 5 times and 90% of the participants enrolled in case management. 15 drug users were referred to methadone programs and 3 drug users were referred to abstinence programs.
(7) HIV/AIDS Information and Publication Services
Information services: We provided the services through telephone calls, e-mail, web message board and MSN. As the people infected with HIV are getting younger, web message board and MSN provides a good and confidential channel for them to communicate among themselves. The social workers and HIV-coordinator also reply to their questions about treatment and policies on HIV issues every day. We provided 1,551 times of information services in 2007, among them 71% were people infected with HIV and 29% were non-HIV people.
Publication Service: Lourdes Association is the only organization which provides publication services to PLWHA. We published 1,000 copies of a monthly newsletter with the latest HIV/AIDS information on treatment and self-care. In 2007 we published 4 new booklets of "The Art of Disclosure", "Information for People Newly Diagnosed with HIV", "HIV Information for Women" and "HIV Treatment" with 1,000 copies respectively. All the publications were sent to the AIDS hospitals, prisoners, AIDS NGOs and PLWHA, and could be downloaded on our web site.
Translation Service: In Taiwan, Harm Reduction theory is very new and there is no book about this subject. Sister Teresa Hsieh translated "Over the Influence- The Harm Reduction Guide for Managing Drugs and Alcohol" by Patt Denning into Chinese and the book was published by Loving Psychology Publishers in Taiwan .
(8) HIV/AIDS Education and Advocacy
HIV/AIDS-awareness education: We are often invited to give talks to public health workers, social workers, teachers and prison officers. Our emphasis is on issues of discrimination against PLWHA, the difficulties they encounter and how to work with them. In 2007 we gave a total of 116 talks with 5,559 participants.
Social Work Students HIV Education: The research of the social work students in the universities shows that the willingness of service to PLWHA is very low. Therefore, Lourdes Association with partnership ofTaiwan United Way conducted a project of giving HIV/AIDS education to the social work students islandwide. We gave 23 talks to the social work students in 18 universities. Total 828 students attended the talks and the evaluation showed that their knowledge of HIV/AIDS and willingness of service to PLWHA have increased.
Advocacy: In Taiwan, people infected with HIV/AIDS suffer discrimination in health care, employment, housing and education. We co-operate with the PLWHA rights group for improving their human rights. Sister Teresa Hsieh, the Executive Director was a member of HIV/AIDS Advisory Committees of the Center of Disease Control and Taipei City Department of Health. She was actively involved with policy making issues. She participated in the drawing up of the regulations for protecting the rights of PWLHA in theCenter of Disease Control.
(9) Outreach Work in China
In partnership with German Misereor, Sister Teresa Hsieh and Paul Hsu visited Xi-An, Shen-Yang and Ji-Lin Diocesan Social Service Centers for 4 weeks in 2007 and gave training to those Sisters and lay people who worked with HIV/AIDS. They also gave social work training to the Priests and staff members of the diocesan social service centers.
SPECIAL EVENTS
(1) 10th Anniversay Celebration
In June 2007 Lourdes Association celebrated its 10 anniversary. The thanksgiving service and concert were held in the Christ the King Church inTaipei. The former Archbishop Di-Gang who invited the Daughters of Charity to start the work with AIDS opened the thanksgiving celebration. About 200 of the government officers, the Catholics, Sisters from the Daughters of Charity, the staff, the volunteers and HIV friends joyfully celebrated this event.
(2) The 2nd International AIDS Conference
In 2007 Lourdes Association, in partnership with Taiwan University Hospital, organized the International AIDS Conference in Taipei. 100 HIV friends and workers participated in this Conference in a holiday resort for two days. An English and a Canadian speakers who were HIV positive were invited to the Conference. The contents of the conference covered self-care, alternative treatment, relationships, disclosure, self support groups and empowerment.
THE WORK TEAM
(1) Training of the Staff
There are 14 staff members. Staff members are highly encouraged to attend training, courses, workshops and reading groups in order to improve their competence and professional knowledge, skills and values. They are also encouraged to participate in the development of the work and the management of the organization. It is our belief that the clients will obtain better services if the staff members have better training and our organization has sound management.
Training: This year staff members participated in 21 training courses related to social work, harm reduction, family therapy, narrative therapy, etc.
Reading groups: The staff members had 29 times reading groups and discussion. The reading materials were related to self-awareness, counseling skills, family therapy, writing proposals, etc.
Training Abroad: The supervisor and two social workers went to visit drug programs in Honkong. The Supervisor, two HIV co-ordinators and an HIV volunteer went to attend 8th International Conference on AIDS of Asia Pacific in Sri Lanka in August 2007. They also gave presentations on "A Support Group to the Newly Diagnosed Gay Men" and "The Experience of Disclosing HIV Status in Public" at the Conference. They were empowered through their international experiences. The staff team also benefited from their rich experiences.
Interior Supervision: The supervisors met with the staff members regularly. The staff had individual supervision monthly and group supervision bi-monthly. This year 171 individual supervisions and 32 group supervisions were conducted. Sister Teresa Hsieh also had 50 times individual supervision with staff members for management and personal development issues.
External Supervision: We are in partnership with United Way Taiwan . Their Supervisor assesses and evaluates our project twice a year. At the end of the year, Professor Yi-Zhen Chang, a social work professor was invited to evaluate our various programs with all the staff members.
Team support: All the staff members attended a day retreat in summer and two-days retreat in winter. So that we could have deeper sharing about our work experience and personal reflection during the retreats.
AIDS NGOs group supervision: We organized 3 NGO AIDS workers group supervision sessions at which the AIDS workers from different organizations could share their experiences. Social work professors were invited to lead the groups. 81 participants attended these supervision sessions.
(2) Volunteers training and Practice Students
Volunteers and practice students are our valuable resources. Considering the prejudice against the PLWHA, we were lucky to have about 100 volunteers in 2007. Five social students from 4 different universities had social work practice in Lourdes.
Services: 38 volunteers provided services to PLWHA in our Friendship Centers, 17 volunteers visited HIV prisoners in the prisons and 9 volunteers helped with administration services.
Training: We organized 5 recruitment training courses and in-service training with 195 participants.
HIV positive volunteers: We gave special training to 16 HIV friends to be our "buddies". They gave support to 28 newly diagnosed HIV positive people in 2007. These volunteers had extra supervision and training because they were easily affected by other HIV positive people's life experience.
FINANCIAL REPORT IN 2007
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Total Income
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US$532,254
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Total Expense
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US$438,087
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Balance
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US$94,167
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The source of income:
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Government sectors
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US$148,427
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28%
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United Way Taiwan
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68,516
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13%
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Various Donors
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307,207
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58%
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Interest
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8,104
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1%
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